Morning Report Unknown

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Morning Report Unknown 141
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Case Presentation

• An 80 year old female with no significant past
  medical history Georgia for a golfing trip at one
  of the local retirement communities 2 weeks prior
  to admission to the hospital.
• She presented to the emergency room with fever,
  malaise, myalgia, headache, and chills.

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Labs

• WBC 2.0 with 82 neutrophils
• Platelets 130,000 (normal range gt 160,000)
• AST 50 (nml range lt 35)
• Alk phos 120 (nml range 35-110)

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Peripheral smear
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Questions

• What is the diagnosis?
• What is the treatment?

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Answers
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• Human Ehrlichiosis
• Treatment - doxycycline

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Peripheral smear
morulae
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Human Ehrlichiosis

• Obligate intracellular bacteria that grown in
  membrane bound vacoules in human and animal WBCs
• Two main human diseases
• Human monocytic ehrlichiosis
• Human granulocytic anaplasmosis (formerly human
  granulocytic ehrlichiosis)

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• Main vector is the lone star tick for HME
• Ixodes scapularis is main vector for lyme disease
  and babesiosis

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Lone star tick
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Comparative sizes of ticks
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Clinical Manifestations

• Can present acutely, subacute, or chronic
• Most have 1-2 week incubation time
• Fever
• Malaise, myalgia, headache, chills (2/3)
• Nausea, vomiting, arthralgia, cough (25-50)

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Laboratory Findings

• Leukopenia with left shift (lymphopenia or
  neutropenia)
• Thrombocytopenia
• Transaminitis
• Elevated LDH
• Elevated Alkaline Phosphatase